Marcel Slockers

78 Chapter 5 In this cohort, unnatural death (26%, CI 21–32%), cardiovascular disease (22%, CI 17–22%) and cancer (17%, CI 13–22%) were the main causes of death(table 1). Intentional injuries (suicide and homicide) caused 50% of all unnatural deaths in homeless people. In total there were 34 deaths for intentional injury, of which 25 for suicide. Table 1. Proportion (%, CI) of deaths by cause of death in a Dutch homeless cohort and Rotterdam population, 2001–2010 Homeless, % (95% CI) Rotterdam population, % (95% CI) Infectious diseases 0.05 (0.03–0.08) 0.02 (0.01–0.02) Cancer 0.17 (0.13–0.22) 0.27 (0.27–0.27) Psychiatric disorders 0.05(0.03–0.08) 0.05 (0.05–0.06)) Cardiovascular diseases 0.22 (0.17–0.27) 0.31 (0.31–0.32) Respiratory diseases 0.06 (0.03–0.10) 0.10 (0.10–0.10) Gastrointestinal diseases 0.07 (0.05–0.11) 0.05 (0.04–0.06) Other diseases a 0.13 (0.09–0.17) 0.16 (0.16–0.16) Unnatural death b 0.26 (0.21–0.32) 0.04 (0.04–0.04) Accidental poisoning 0.07 (0.04–0.11) 0.00 (0.00–0.01) Other accidents c 0.06(0.04–0.10) 0.02 (0.02–0.03) Intentional injury 0.13 (0.09–0.18) 0.01 (0.01–0.01) Suicide 0.11 (0.07–0.15) 0.01 (0.01–0.01) a. Mainly unspecified or ill-defined disorders (50%), endocrine diseases (20%) and neurologic diseases (20%). b. Unnatural death includes unintentional injuries (accidental poisoning and other accidents) and intentional injuries (suicide and homicide). c. Other accidents: all accidents other than poisoning combined, e.g. traffic accidents, accidental falls, accidental drowning, burns. With a share of 26% unnatural death was a much larger cause of death in homeless people than in the general population of Rotterdam (4%). Compared to the general population homeless people had an excess risk of death for all causes. The largest mortality differences with Rotterdam citizens were observed for unnatural death (14.8, CI 11.5–18.7), infectious diseases (10.0, CI 5.2–17.5) and psychiatric disorders (7.7 CI 4.0–13.5) (table 2).